Secure Messaging and Telephone Use for Clinician-to-Clinician Communication

This cohort study investigates the association of use of text-based secured messaging with telephone use among resident physicians.


Introduction
Communication between clinicians is essential for effective patient care.Historically, the telephone has been the primary method for clinician-to-clinician communication.However, with the advent of mobile devices and electronic health record (EHR) systems, text-based secure messaging platforms have grown in use rapidly, with studies suggesting a doubling in use over the past 5 years. 1,2Despite widespread adoption, the association of secure messaging with clinician communication practices remains poorly understood.Many have hypothesized that secure messaging may replace highly interruptive telephone calls, potentially leading to more efficient workflows 3 ; however, secure messaging may also be used alongside telephone to increase the overall burden of communication. 4 This study assesses the association between secure messaging and telephone use.

Methods
The Washington University Institutional Review Board approved this cohort study with a waiver of informed consent because it was a retrospective study with minimal risk to participants.The study is reported using the STROBE guidelines.All resident physicians at Barnes-Jewish Hospital between August 1, 2022, and January 31, 2023, were included except 3 for whom sex was missing.Each resident was issued a smartphone at residency enrollment with instructions to use it for workplace communication; the same phone was used throughout residency.
Metadata on monthly telephone minutes were extracted from mobile device billing data.
Metadata on EHR-integrated secure messaging use (Secure Chat, Epic Systems; implemented in 2019) were extracted from the EHR data warehouse. 2Monthly secure messaging volume was measured as the sum of all messages sent and received.Data were collected for 6 months and analyzed at the person-month level; 347 person-months with 0 telephone minutes and 0 secure messages were excluded.
To assess the association between secure messaging volume and telephone minutes, a mixedeffects linear regression model was created.Secure messaging volume and sex were used as fixed effects, and resident and clinical rotation were used as random effects to adjust for individual preferences and differences in communication need between rotations.The most frequent EHR login context for each month was used to determine clinical rotation assignments.A 2-sided P < .05 was used for statistical significance.Analysis was conducted using SAS statistical software version 9.4 (SAS Institute).

Results
A total of 1057 resident physicians (594 male [56.2%]) and 5995 person-months were included, representing 18 specialties and 231 clinical rotations (Table 1).Each resident sent or received a median (IQR) of 148 (25-561) secure messages and used a median (IQR) of 166 (21-380) telephone minutes per month.In multivariable analysis, moving from the 25th to 75th percentile (from 25 to 561 messages/mo) in monthly secure messaging volume was associated with an increase in monthly telephone call minutes of 73 minutes (95% CI, 66-80 minutes; P < .001)(Table 2).

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Author affiliations and article information are listed at the end of this article.
Open Access.This is an open access article distributed under the terms of the CC-BY License.This study has limitations.The association between secure messaging and telephone use is confounded by certain clinical settings having higher communication needs; we adjusted for this confounder using clinical rotation as a proxy.However, clinical rotation boundaries were not necessarily aligned with the calendar months of analysis.The possibility of residual confounding may exist.Not all telephone and secure messaging use may have been for patient care; similarly, residents may have sometimes used telephones other than the one issued to them.This was a single-center study of resident physicians, and results may not generalize to other settings or clinician groups.

Table 1 .
5his cohort study found that after adjusting for sex, individual preferences, and clinical work setting, months with increased secure messaging use also had increased telephone use.This result is consistent with prior research showing that the use of new workplace communication channels may not mitigate the use of existing channels,5highlighting the possibility that secure messaging may be Study Cohort Characteristics and Associated Median Messaging and Telephone Volume Open. 2024;7(6):e2417781.doi:10.1001/jamanetworkopen.2024.17781(Reprinted) June 20, 2024 1/4 Downloaded from jamanetwork.comby guest on 06/26/2024 Discussion